Individual
MS. LIL SUSANA BASULTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9110 SW 137TH AVE APT 208, MIAMI, FL 33186-1414
(786) 510-1774
Mailing address
9110 SW 137TH AVE APT 208, MIAMI, FL 33186-1414
(786) 510-1774
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
06/05/2019
Last updated
06/05/2019
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